Incarceration Rates Research Articles

Abstract 4118402: National Burden, Trends, and Racial Disparities in Cardiovascular Mortality Among Incarcerated Individuals in the United States from 2000-2019

Background: Cardiovascular disease is the leading cause of death in the U.S. Mass incarceration is a national public health issue, with the US having the highest incarceration rate in the world. However, there is a paucity of data on cardiovascular mortality among incarcerated individuals, or how the racialization of mass incarceration contributes to cardiovascular health inequities. The aim of this study was to evaluate the burden of cardiovascular mortality, trends in cardiovascular deaths, as well as racial differences in cardiovascular death and receipt of care among those incarcerated in U.S. state prisons from 2001-2019. Methods: We utilized the database “Mortality in Correctional Institutions: ICD-10 Diagnosis Codes for Natural Deaths Occurring in State Prison or Local Jail Custody, 2000-2019” from the United States Bureau of Justice Statistics. This database collects inmate death records from each of the nation’s 50 state prison systems. We extracted all deaths related to cardiovascular causes to evaluate the epidemiology of individuals with cardiovascular death, trends in cardiovascular death rates, and differences between racial groups. Results: From 2000-2019, there were a total of 18227 (28.0%) deaths secondary to cardiovascular causes among those incarcerated in US state prisons. The rate of CV death increased from 71.3 per 100,000 persons in 2001 to 94 per 100,000 persons in 2019. Black individuals who died while incarcerated had higher rates of death related to a cardiovascular cause than White individuals (30.9% vs. 27.8%, p<0.0001). Black individuals had higher rates of death due to ischemic heart disease (23.2% vs 21.9%) and hypertensive-related cardiovascular deaths (3.71% vs. 2.96%) as compared to white counterparts (p<0.001). Black incarcerated individuals who died from a cardiovascular cause were less likely to be evaluated by a medical provider in prison (78.6% vs. 81.9%; p<0.0001), were less likely to have a diagnostic test performed (65.3% vs. 69%, p<0.0001), were less likely to receive medications (68.1% vs 72.6%, p<0.001), as well as treatment other than medications (49.1% vs 52.8%, p <0.0001) for the condition which caused death as compared to White counterparts. Conclusions: Deaths due to cardiovascular causes are high among patients incarcerated in US state prisons. Combined with decarceral efforts to address mass incarceration, strategies to ensure quality and equitable cardiovascular care for this population are needed.

The Intersecting Effects of Lifetime Experiences of Homelessness and Incarceration on Cognitive Aging and Dementia Risk Factors in the United States.

Alzheimer's disease and related dementias (ADRD) remain a pressing concern in the US, which also has one of the highest incarceration rates worldwide. Existing research has analyzed dementia risk and care among currently incarcerated and homeless populations; this paper fills a gap by examining later-life cognitive disparities facing formerly incarcerated and/or homeless individuals. Using Health and Retirement Study data (HRS; 1998-2018), we tested whether formerly homeless and/or incarcerated people had earlier onset of cognitive decline, and whether they were more likely to have modifiable risk factors for ADRD than those without such experiences. We estimated prevalence of mild cognitive impairment (MCI), dementia, and self-reported ADRD diagnosis. We also used repeated observations of cognitive functioning coupled with nested nonlinear regression to examine the onset of accelerated cognitive decline. Adjusting for demographic variables, formerly homeless and/or incarcerated participants have increased odds of having risk factors for dementia, including smoking, drinking alcohol, depression, mental illness, and discrimination from healthcare providers and police. Diagnosis of MCI and ADRD were more common among participants reporting a history of incarceration or homelessness. Nested nonlinear regression revealed that previous experiences of incarceration or homelessness-alone or together-are associated with earlier onset of accelerated cognitive decline compared to those who experienced neither. This study suggests that, even if they occur earlier in life, homelessness and incarceration experiences may increase risk of poorer cognitive health in late life. Future work is warranted to understand the lifelong consequences linked to this adversity.

Narrative Coherence and Relational Agency: Unraveling Transitions Into and Out of Alberta Correctional Facilities for People Living With HIV.

Incarcerated populations in Canada face significant health and social challenges during transitions into and out of correctional facilities. These transitions around facilities pose disproportionate barriers to care for people living with HIV. Further research is crucial to comprehend these challenges and reimagine care concepts for people who experience structural marginalization. In this article, experiences of transitions into and out of Alberta correctional facilities for people living with HIV are explored using narrative inquiry. Conducted in a Western Canadian city from 2021 to 2022, the inquiry revolved around two men living with HIV and a history of incarceration. Through co-creating field texts and narrative accounts, their unique experiences of transitions were explored through a collaborative process of analysis. Narrative threads from Bruce and Kyle showcased a lack of narrative coherence and the presence of tensions in their lives, while also emphasizing relational agency. The findings provide avenues for health, social, and justice practitioners who support and care for individuals living with HIV and a history of incarceration to think differently about transitions. By highlighting the importance of attending to the unique identities of individuals and relationships from a position of relational agency, the study advances our understanding of transitions. Recommendations for practice and policy include (a) fostering relational agency among practitioners; (b) challenging conventional views of transitions around correctional settings; (c) incorporating peer-based programming into support services; and (d) reconsidering health, justice, and social systems to better support communities disproportionately affected by high rates of incarceration and HIV.

Algorithmic Risk Assessment in the Hands of Humans

We evaluate the impacts of adopting algorithmic risk assessments in sentencing. We find that judges changed sentencing practices in response to the risk assessment, but that discretion played a large role in mediating its impact. Judges deviated from the recommendations associated with the algorithm in systematic ways, suggestive of alternative objectives. As a result, risk assessment did not lead to detectable gains in terms of public safety or reduced incarceration rates. Using simulations, we show that strict adherence to the sentencing recommendations associated with the algorithm would have had benefits (less incarceration) but also some costs (increased sentences for youth). (JEL D81, D91, H76, K41, K42)

Characterizing a syndemic: STI symptoms, substance use & violence among incarcerated Peruvian women

Abstract Background Despite increasing rates of incarceration and sexually transmitted infections (STIs) among women globally, STI epidemiological data for this vulnerable at-risk population is limited. We therefore characterized patterns of STI symptoms and explored covariates and drivers of STI symptoms among incarcerated women in Peru. Methods Among 249 incarcerated women surveyed on substance use, depression, sexual behavior, STI symptoms and violence, univariate and bivariate analysis informed a latent profile analysis (LPA) and logistic regression assessing for syndemic associations between violence, substance use, and STI symptoms. Results Most participants were Peruvian (93.5%), in their late 30s (median=37; range:18-70 years), sentenced to < 5 years (86.6%) and had completed high school (78.7%). 36.9 had ≥2 STI; A minority were pregnant (2.6%), had children residing with them in prison (7.2%); symptoms. The LPA model with the best fit revealed the largest (39%) group with a ‘syndemic’ profile involving co-occurrence of multiple STI symptoms, substance use, and experiences of interpersonal violence (IPV); 86.6% of this latent class were <50 years old. The substance use and violence ‘syndemic’ profile was associated significantly higher likelihood of having multiple STI symptoms (2+ symptoms: PR = 1.88 (95% CI 1.18, 2.99) or 3+ symptoms PR = 2.55 (95% CI 1.32, 4.93). Conclusions and Recommendations The syndemic of younger incarcerated women with substance use and IPV with STI symptoms portends a group at substantially higher risk for HIV and given the structured setting of prisons, should be routinely screened for and treated for STIs. Moreover, these settings can and should screen for and address substance use and IPV and intervene before these women are released to community settings to not only improve individual but public health needs. Key messages • In line with syndemic theory, incarcerated women presenting with multiple STI symptoms (≥2) were more likely to be engaged in substance use (illicit drug use and/or alcohol) and experience violence. • Post-hoc analysis also revealed the rate of substance use was higher among women who engaged in commercial sex work (CSW) pre-incarceration compared to those who were not engaged in CSW.

What happens to imprisonment rates when a progressive prosecutor is elected: Quasi-experimental evidence from Cook County

There has been a clear recognition in recent years that the United States' extremely high rates of imprisonment, coupled with significant racial disparities, are problematic. The progressive prosecutor movement has developed in response to these issues and has gained increasing attention over the past decade. Despite the growing importance of the progressive prosecutor movement in criminal legal reform efforts, we know little about the extent to which electing a progressive chief prosecutor actually leads to reductions in overall imprisonment rates and racial disparities in imprisonment, with no studies to our knowledge using data that capture preelection differences in imprisonment trends across jurisdictions. In this study, we begin to fill this gap by examining the implications of the 2016 election of Kim Foxx in Cook County, Illinois, for overall, Black, White, and Latinx imprisonment rates. Employing a quasi-experimental synthetic control approach that accounts for preelection differences in imprisonment trends, our findings suggest that Kim Foxx's election led to a reduction in the imprisonment rate overall, as well as for Black and White individuals. However, our findings suggest that substantial racial disparities in imprisonment persisted after her election.

A soccer-based intervention improves incarcerated individuals' behaviour and public acceptance through group bonding.

As incarceration rates rise globally, the need to reduce re-offending grows increasingly urgent. We investigate whether positive group bonds can improve behaviours among incarcerated people via a unique soccer-based prison intervention, the Twinning Project. We analyse effects of participation compared to a control group (study 1, n = 676, n = 1,874 control cases) and longitudinal patterns of social cohesion underlying these effects (study 2, n = 388) in the United Kingdom. We also explore desistance from crime after release (study 3, n = 249) in the United Kingdom and the United States. As law-abiding behaviour also requires a supportive receiving community, we assessed factors influencing willingness to employ formerly incarcerated people in online samples in the United Kingdom and the United States (studies 4-9, n = 1,797). Results indicate that social bonding relates to both improved behaviour within prison and increased willingness of receiving communities to support re-integration efforts. Harnessing the power of group identities both within prison and receiving communities can help to address the global incarceration crisis.

Incarceration Postpartum: Is There a Right to Prison Nurseries?

Rising rates of female incarceration within the United States are incompatible with the lack of federal standards outlining the rights of incarcerated mothers and their children. A robust body of evidence demonstrates that prison nurseries, programmes designed for mothers to keep their infants under their care during detainment or incarceration, provide essential and beneficial care that could not otherwise be achieved within the current carceral infrastructure. These benefits include facilitation of breastfeeding, bonding during a critical period of child development, and decreased recidivism rates for participants. Legal precedent exists to support the rights of the mother to continue to parent their child but remains in stark opposition to current prison infrastructure that could allow them to do so. Existing state policies also have inconsistent mechanisms for determining child eligibility and should move to centre decision-making on a case-by-case basis. This work will demonstrate that a just society, supported by law and ensuring maternal-child welfare supports the establishment of prison nursery programmes as a part of the existing right to healthcare for incarcerated individuals.

Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected effects of policy alternatives: a mathematical modelling study

Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. We aimed to quantify the impact of historical and future incarceration policies on the tuberculosis epidemic, accounting for effects in and beyond prisons. In this modelling study, we calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. The model was fit independently for each country to incarceration and tuberculosis data from 1990 to 2023 (specific dates were country dependent). The model does not include HIV, drug resistance, gender or sex, or age structure. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the effect of alternative incarceration policies on future population tuberculosis incidence. Population tuberculosis incidence in 2019 was 29·4% (95% uncertainty interval [UI] 23·9-36·8) higher than expected without the rise in incarceration since 1990, corresponding to 34 393 (28 295-42 579) excess incident cases across countries. The incarceration tPAF in 2019 was 27·2% (20·9-35·8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared with a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico. The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognised to date. International health agencies, ministries of justice, and national tuberculosis programmes should collaborate to address this health crisis with comprehensive strategies, including decarceration. National Institutes of Health.

Using a Community-Engaged Survey to Describe Prison Environments and Measure the Mental Health Status of Correctional Staff and Incarcerated Individuals

The United States has the highest incarceration rate in the world. Incarceration is associated with significant negative mental health implications for both the corrections staff who work in prisons and the individuals incarcerated in them. Despite their scale and impacts, prisons are one of the country’s least transparent and most understudied public institutions. Where research on prisons does exist, it is often focused on either the corrections staff population or the incarcerated population. Moreover, the perspectives of those most directly affected, incarcerated populations and correctional staff are rarely included in the process. In this study, we sought to focus on understanding the entire prison ecosystem, measuring the mental health status of corrections staff and incarcerated individuals, and describing potential interrelated factors in the prison environment that may affect these outcomes. We used a community-engaged process to develop a prison survey to measure the prison environment in a pilot facility in rural Vermont, incorporating the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Mental Health 2a instrument to measure the mental health status of the corrections staff and incarcerated individuals. Focus groups and interviews were conducted to inform survey development and understand factors affecting the mental health of these populations. Surveys were administered at three time points.

Abstract B171: Using a transdisciplinary collaboration process to create a plan to address prostate cancer disparities

Abstract WI ranks highest in the US for overall cancer incidence and mortality among Black/African American (Black) individuals. Prostate cancer (PC) is the most frequently diagnosed cancer among men in WI and the second leading cause of cancer death. This region has numerous challenges including segregation, poverty, educational achievement gaps, and high Black imprisonment rates which impact PC awareness, screening, and treatment. To effectively address a problem as complex as prostate cancer disparities, multiple perspectives are needed. We brought together a transdisciplinary team that integrated community and academic expertise to develop a shared understanding of prostate cancer disparities and potential causes and to create a community action and research agenda. The team met every other week for 16 months. During that time, This team engaged in a facilitated process developed through our Community and Cancer Science Network that included: 1) Incubation: co-learning about the multi-factorial causes of PC disparities by reviewing available data, engaging experts, and seeking input from researchers, health care providers and community members; 2) Innovation: using this information to consider potential solutions to create a draft plan; and 3) Integration: seeking feedback to ensure the draft plan met the needs of diverse audiences and then refined the solutions. During the Incubation phase. the team reviewed available literature and data; developed a root causes analysis of disparities, conducted surveys, interviews and discussion sessions with researchers, healthcare providers, and community members (n=98); invited presentations by relevant experts and survivors, and engaged in robust discussions. In the Innovation phase, the team analyzed the data and reflected on opportunities to address the issues outlined in the root cause analysis. Potential solutions were assessed for fit and feasibility. Finally, in the Integration Phase, the team conducted a series of town halls with community members and researchers (n=70) to review the draft plan and seek feedback. The team used the feedback to refine the plan and consider next steps. Final recommendations include: 1) Patient navigation to assist men with PC at diagnosis; 2) A trusted messenger campaign to increase PC awareness; 3) Increase provider and community awareness of genetic risk; 4) Patient-provider forums to build relationships and trust; 5) Expand survivor support offerings for Black men with PC; 6) Improve PC screening education; 7) Increase provider awareness of current screening guidelines; 8) Expand research into the role of stress in PC. Our transdisciplinary approach is effective in engaging and blending diverse perspectives to generate solutions to complex problems. Future work will sustain this approach in implementing solutions through collaborative efforts. Citation Format: Tobi Cawthra, Kevin Izard, Robert Allen, Darryl Davidson, Chris Nielson, Ambrose Wilson-Brown, Deepak Kilari, Marquayla Ellison, Dev Karan, Ericka Sinclari, Alvin Flowers, Kyle Ashley, Leonard Wilson, Marcus Hogans, Kenneth Jacobsohn, Melinda Stolley. Using a transdisciplinary collaboration process to create a plan to address prostate cancer disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B171.

County-level jail and state-level prison incarceration and cancer mortality in the United States.

This study examined the association of county-level jail and state-level prison incarceration rates and cancer mortality rates in the United States. Incarceration rates (1995-2018) were sourced from national data and categorized into quartiles. County- and state-level mortality rates (2000-2019) with invasive cancer as the underlying cause of death were obtained from the National Vital Statistics System. Compared with the first quartile (lowest incarceration rate), the second, third, and fourth quartiles (highest incarceration rate) of county-level jail incarceration rate were associated with 1.3%, 2.3%, and 3.9% higher county-level cancer mortality rates, respectively, in adjusted analyses. Compared with the first quartile, the second, third, and fourth quartiles of state-level prison incarceration rate were associated with 1.7%, 2.5%, and 3.9% higher state-level cancer mortality rates, respectively. Associations were more pronounced for liver and lung cancers. Addressing adverse effects of mass incarceration may potentially improve cancer outcomes in affected communities.

Decarceration in Southern Europe: Notes on Climate Change in the Penal Field

AbstractAgainst the backdrop of the economic and political crises affecting Europe in the late 2000s and early 2010s, incarceration rates began to shrink in many European countries, ushering in a decarceration period that continues to this day—albeit with cross-border divergences. In fact, Europe was the world region with the greatest decline in incarceration rates in the 2010s. Evidently, this unexpected shift stands in stark contrast to the penal populism policies characterising penality in global north regions in the 1990s and 2000s, as well as to the mass incarceration path still followed by many global south jurisdictions in the 2020s. Spain is a suitable national case to examine this recent turn, since Spanish incarceration rates increased almost eightfold in just three decades, before an intriguing and steady decline began that is almost unparalleled in western Europe. This paper focuses on the Spanish case, exploring the background and proximate causes that have enabled the current decarceration scenario. In addition, it scrutinises if and to what extent the changes witnessed in the Spanish case reverberate across wider European regions. In so doing, the paper attempts to grasp the climate change impacting the penal field in many global north jurisdictions.

Deaths in jail: a retrospective analysis of autopsies performed at the Legal Medicine Unit of Pavia (1999-2022).

The high rate of incarceration, now exceeding 11.5 million people worldwide, has raised concerns about the conditions within penal institutions, such as the consequences of incarceration on the person. This retrospective study aims to investigate the issue of death in custody, exploring the relationship between incarceration, health vulnerabilities, and death from the forensic pathologist's point of view. We analyzed, from a forensic, clinical and toxicological perspective, 86 cases of deaths in detention facilities in North-Western Italy from 1999 to 2022. The analysis has shown that suicide, mainly committed by hanging, plastic bag suffocation and butane intoxication, represents the leading type of violent death (52%), followed by accidental deaths (16%). On the other hand, cardiovascular diseases are the leading cause of natural deaths (42%), followed by infectious diseases (especially HIV-related). The present study identifies the most frequent and critical situations and risk factors related to death in custody and the profile of the inmate who is at a higher risk of death, allowing to highlight the issues to be addressed from a public health point of view. On the whole, it calls for comprehensive reforms, aligned with international human rights standards, addressing mental and physical care gaps, improving correctional officers' education, and training, and focusing on rehabilitation with well-being and dignity.

Health disparities among incarcerated populations: a crucial laboratory and pathology review.

The United States notoriously has one of the highest rates of incarceration in the world, yet scant attention to the health care needs of those incarcerated exists within laboratory medicine and pathology training and education. This article explores health disparities among incarcerated and released individuals regarding diagnostic laboratory testing and pathology services. A literature search was conducted for articles published between 2002 and 2023 using keywords including "healthcare," "incarcerated," "laboratory services," "pathology services," and "health insurance for prisoners." Central themes were extracted and discussed to reveal the realities of health care during and after release from incarceration. Excluded from the analysis were articles about the immediate or extended family of incarcerated persons. Incarcerated individuals have an increased risk for the development and exacerbation of communicable and noncommunicable diseases and mental health disorders, which results in exceedingly high morbidity and mortality rates. Policy changes are needed to mitigate disparities and improve health outcomes for incarcerated and released persons. Central to these disparities is decreased access to laboratory and pathology services, impeded by inadequate health care funding for these carceral institutions. Providing additional funding to the carceral system's health care budget is necessary to improve access to pathology and laboratory services.

Attitudes toward incarceration, neuronormalization and psychological treatment for violent offenders

ABSTRACT Incarceration is a popular method of dealing with violent offenders. However, incarceration does not rehabilitate many violent offenders and often increases recidivism, which suggests a need for different interventions. Because public opinion has an important influence on the criminal justice system, we compared attitudes toward two alternative interventions and incarceration. These alternative interventions were brain-based treatments (i.e. neuronormalization) and psychological therapies. In two experiments, participants were randomly assigned to one of these three interventions and answered questions about their use with violent offenders in general and two severely violent cases: a domestic violence homicide offender and a child sex offender. For violent offenders in general, participants were more positive toward neuronormalization and psychological therapies than incarceration. However, when evaluating the two severely violent cases, participants were most positive toward incarceration. These findings highlight that people were generally amenable to alternative treatments for violent offenders, but these attitudes flipped in favor of incarceration when confronted with serious individual cases of violence. Our findings suggest that disseminating evidence for the effectiveness of alternative treatments may eventually lead to positive attitudes and policy change. Doing so could simultaneously lead to lower rates of incarceration and recidivism and create safer communities.

Minnesota’s energy paradox: Household energy insecurity in the face of racial and economic disparities

The “Minnesota Paradox” points to the nation-leading socioeconomic indicators enjoyed in Minnesota that belie some of the largest racial disparities between the state’s majority White and minority Black populations. The Minnesota Paradox has been identified in indicators with complex, structural social determinants: income, employment, educational outcomes, incarceration rates, home ownership, and even drowning. In this paper, we ask if similar disparities exist in access to shared infrastructure systems, focusing on the electric system, an essential service delivered by heavily regulated public utilities. We examine disparities in access to electricity service across three dimensions: utility disconnection, service reliability, and availability of the grid to host distributed energy resources. We quantify disparities across Census block groups by leveraging unique, high-resolution datasets that have only recently been made publicly available. We find significant and pervasive evidence of the Minnesota Paradox across utility disconnection and service reliability. Across a battery of regression models, we find that living in neighborhoods with a greater concentration of people of color is associated with a statistically and practically significant difference in the likelihood of disconnection from service due to non-payment and the experience of extended power outages. We also find a positive association between communities with larger populations of people of color and hosting capacity, suggesting a potential opportunity to affirmatively address disparities in energy insecurity in the energy transition. These findings shed light on the pervasive nature of the Minnesota Paradox in the electric system, which underscores the pressing need for policy initiatives to rectify deep-seated inequalities and ensure all communities have equitable access to universal basic utility service and reliable, clean energy.

A review of applied behavior analysis within the criminal justice system

AbstractMass incarceration rates have become a financial burden on the country and in 2023, the United States was faced with one of the highest recidivism rates worldwide, with approximately 44% of individuals returning to prison within a year of their release. Although various programs are available to incarcerated individuals and for those considered at risk for offending, access to these programs varies by jurisdiction and the effectiveness in preventing offenses, reducing recidivism, and fostering rehabilitation is not entirely known. In response to recidivism and incarceration rates, there has been a plea for a change in the criminal justice system, with an emphasis on involving behavior analysts. However, the extent of the application of behavior‐analytic interventions within the criminal justice system in the research literature is unclear. Thus, the purpose of the current review was to examine the existing experimental literature to determine the state of this research topic.

Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected impacts of policy alternatives: A mathematical modeling study.

Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. The full impact of incarceration on the tuberculosis epidemic, accounting for effects beyond prisons, has never been quantified. We calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the impact of alternative incarceration policies on future population tuberculosis incidence. Population tuberculosis incidence in 2019 was 29.4% (95% UI, 23.9-36.8) higher than expected without the rise in incarceration since 1990, corresponding to 34,393 (95% UI, 28,295-42,579) excess incident cases across countries. The incarceration tPAF in 2019 was 27.2% (95% UI, 20.9-35.8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared to a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico. The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognized to-date. International health agencies, ministries of justice, and national tuberculosis programs should collaborate to address this health crisis with comprehensive strategies, including decarceration. National Institutes of Health.

Mass Incarceration, Maternal Vulnerability, and Birth Outcomes Across U.S. Counties

ObjectivesTo examine the associations among mass incarceration, maternal vulnerability, and disparities in birth outcomes across U.S. counties, utilizing an ecological model and reproductive justice perspective was used. This study tests whether mass incarceration is associated with infant mortality and low birthweight across U.S. counties, and whether maternal vulnerability explains the relationship between mass incarceration and birth disparities.MethodsData were derived from a variety of public sources and were merged using federal FIPS codes. Outcomes from the CDC Vitality Statistics include percent low birth weight births (births below 2499 g divided by singleton births to women aged 20 to 39) and infant mortality (infant deaths per 1000 live births). Black–White rate ratios were calculated for the birth outcomes to specifically examine the large Black–White disparity in birth outcomes. The analysis controlled for urbanicity, income inequality, median household income, residential segregation, and southern region, as well as a fixed effect for state level differences.ResultsFindings show that counties with higher rates of incarceration have higher prevalence of infant mortality and low birthweight, as well as greater Black–White disparity in infant mortality. Mass incarceration is associated with increases in adverse birth outcomes and maternal vulnerability partially mediates this relationship.ConclusionsFindings provide evidence that heightened levels of incarceration affect birth outcomes for all residents at the county-level. It is imperative to address the overuse of mass incarceration in order to support adequate reproductive healthcare of vulnerable populations in the United States.